All Case studies /assignments must be done in APA format with a separate sheet for references. F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.
Introduction
This paper presents a case study of F.M., a 68-year-old white man who presents to the emergency department (ED) with severe chest pain. The purpose of this case study is to analyze F.M.’s symptoms, medical history, and physical findings in order to develop a differential diagnosis and propose appropriate interventions. This analysis will follow the guidelines outlined in the APA format and will include a separate sheet for references.
Patient Presentation
F.M. is a 68-year-old white man who presents to the ED in the early afternoon with a 2-day history of severe chest pain. According to F.M., the pain started upon awakening the previous day and has since increased in intensity. His wife had urged him to go to the hospital during the night, but he resisted seeking medical attention until today when the pain became unbearable and was no longer relieved by rest. F.M. appears to be in significant distress and reports that the pain is radiating to his left arm and jaw.
Medical History
F.M. has a past medical history significant for hypertension, hyperlipidemia, and a 20-pack-year smoking history. He has been compliant with his antihypertensive medications but is not currently on any lipid-lowering agents. F.M.’s family history is notable for his father’s premature death from a myocardial infarction at the age of 52. He reports no known drug allergies.
Physical Examination
On physical examination, F.M. appears anxious and diaphoretic. His vital signs are as follows: blood pressure 160/90 mmHg, heart rate 104 beats per minute, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. His lungs are clear to auscultation bilaterally, and there are no abnormal heart sounds or murmurs appreciated. F.M.’s abdomen is soft and non-tender. His lower extremities show no evidence of edema or cyanosis.
Differential Diagnosis
Based on F.M.’s presenting symptoms, medical history, and physical findings, a number of potential diagnoses could be considered. The most concerning diagnosis in this case would be an acute myocardial infarction (AMI), also known as a heart attack. F.M.’s severe chest pain that radiates to his left arm and jaw suggests the involvement of the coronary arteries, which supply blood to the heart muscle. Given F.M.’s risk factors of hypertension, hyperlipidemia, smoking history, and family history of premature myocardial infarction, this diagnosis cannot be ruled out. Other potential diagnoses to consider include unstable angina, which is characterized by chest pain at rest or with minimal exertion and is often a precursor to AMI, as well as gastroesophageal reflux disease (GERD), which can present with chest pain that may radiate to the left arm.
Interventions
Given the potential seriousness of F.M.’s presentation, it is essential to initiate appropriate interventions promptly. The first priority is to ensure the patient’s stability. F.M. should be placed on a cardiac monitor to assess for any dysrhythmias and continuous oxygen should be administered to maintain adequate oxygen saturation. Vital signs should be monitored frequently, and any changes should be promptly addressed.
Pain management is also a crucial aspect of F.M.’s care. Nitroglycerin, a vasodilator, should be administered sublingually to relieve F.M.’s chest pain. As F.M. is experiencing ongoing pain despite rest, nitroglycerin may need to be administered in repeat doses or a continuous infusion may be considered. Additionally, analgesics such as opioids may be indicated to provide further pain relief. It is important to closely monitor F.M.’s response to pain medications and titrate the dosage accordingly.
Discussion
In conclusion, the case study of F.M. demonstrates the importance of promptly assessing and managing a patient presenting with severe chest pain. By carefully considering the patient’s symptoms, medical history, and physical examination findings, a differential diagnosis can be formulated, leading to appropriate interventions. In F.M.’s case, the potential diagnosis of an acute myocardial infarction requires urgent attention and initiation of specific interventions, including cardiac monitoring, administration of nitroglycerin, and pain management. This case highlights the critical role of healthcare professionals in recognizing and responding to cardiovascular emergencies, with a focus on providing timely and effective care.